Justice Department Tags NJ Doctor for $5.25 Million in Medicare Fraud Qui Tam Action
[Updated June 2019] Dr. Labib Riachi and his company, Center for Advanced Pelvic Surgery, must pay $5.25 million to settle a whistleblower complaint brought under the qui tam provisions of the federal False Claims Act. That law allows whistleblowers to file lawsuits on behalf of the federal government in cases where a healthcare practitioner has defrauded Medicare.
The complaint against Dr. Riachi was brought and settled the same day.
According to the complaint, Dr. Riachi was “one of the nation’s most prolific Medicare billers of anorectal manometry, an invasive diagnostic test that involves inserting a probe into a patient’s rectum. He was also among the top Medicare billers for a certain type of electromyography, another diagnostic test.”
Despite billing millions for these services, most were never performed according to prosecutors. Billing Medicare for unnecessary tests for tests never performed is considered fraud.
The complaint also says that Dr. Riachi was using unqualified, unlicensed staff to treat patients.
Prosecutors say that Dr. Riachi’s staff performed thousands of “treatments” even though no one was licensed to do them. After the treatment, Riachi would sign off on the patient’s chart and the procedure or treatment would be billed to Medicare.
Many people believe that Medicare fraud is a victimless crime but it is not. Since taxpayers foot the bill for Medicare and Medicaid, fraud against these programs hurts all taxpayers.
In this case, Dr. Riachi specialized in treating women suffering from incontinence, an embarrassing and sometimes disabling disease. Instead of focusing on how to best treat his patients, Riachi was more interested in how much money he could game from the Medicare system. That often meant using staff with inadequate qualifications to treat his patients. In fact, the Justice Department says no one on his staff was licensed or qualified!
Some of the treatments performed by unqualified staff included electrostimulation of a patient’s vagina. The procedure can be painful and even dangerous if performed incorrectly yet no one on his staff was licensed to do these procedures.
It appears that Riachi became so greedy that he billed for 270 patient visits in 2008 even though he was on vacation in Germany. The following year he billed an additional 300 office visits while in France.
Ultimately, Riachi’s staff cooperated with the government.
Since this post was first written, the State of New Jersey revoked Dr. Riachi’s medical license in March of 2018. According to the state board of medical examiners, he cannot see patients, or offer any medical service or even go to his former medical office when patients may be present. He is eligible to seek another license in five years.
Although he settled the federal Medicare charges with no admission of wrongdoing, the Board of Medical Examiners believed his conduct as alleged in that action constituted fraud, dishonesty and professional misconduct.
Even if he gets his license back in 5 years, Riachi is still prohibited from participating in Medicare or Medicaid programs for 20 years. For many doctors, that means losing a good portion of their income.
In announcing the 20 year Medicare suspension, a spokesperson for the Medicare Inspector General’s Office said, “Twenty years is a substantial period of exclusion and is a clear signal to physicians that they face significant consequences, beyond monetary penalties, for taking advantage of Federal health care programs and their beneficiaries. In cases such as this, collecting money from a wrongdoer is not sufficient and OIG will pursue exclusion to protect our patients and programs.”
The coordinated action here between the state medical examiner, Medicare and the U.S. Department of Justice shows just how far the repercussions of Medicare fraud can extend. For doctors, the fines imposed in a False Claims Act case are not just a cost of doing business. They mean loss of one ‘s license and the inability to later to collect tax dollars even if one’s license is returned.
Patient Tip
When writing this story, we checked Dr. Riachi’s license status. U.S. News and World Report, which rates doctors, hospitals and medical colleges, says his license is active through December of this year (even though he was revoked over a year ago). Always check the state board of medical examiners when determining whether your doctor is licensed to practice. In NJ , that means checking the New Jersey Board of Medical Examiners website. (Most states make this information available for free online.)
While rating sites may be useful, they are not always accurate or up-to-date.
Qui Tam (Whistleblower) Lawsuits and Medicare Fraud
Most Medicare fraud cases are brought to light by insiders with personal knowledge of the fraud or misconduct. The False Claims Act allows these insiders to file a lawsuit in the name of the government. Often called qui tam lawsuits or claims, the suit is filed under seal in a federal court. Medicaid fraud suits can be filed in state courts.
To file a qui tam claim, one must have original source knowledge of the fraud. For that reason, most qui tam claims are brought by present or former employees but we have seen a few successful cases brought by patients.
When the lawsuit is filed, it remains secret while the government investigates. If there is an ultimate recovery, the whistleblower (called a “relator”) can receive between 15% to 30% of whatever the government recovers from the wrongdoer. In a case like Dr. Riachi, that could be a million-dollar award!
Whistleblowers are the new American heroes. Their actions prevent patient harm as well as protecting taxpayers. (State and federal taxes fund Medicare, Medicaid and Tricare.)
Calling a government hotline doesn’t earn you a reward. The only way to collect the reward is by filing an actual complaint in federal court.
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Have information about healthcare fraud? We have helped our whistleblower clients recover over $100 million in awards. For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). You can also download our 11 step guide to whistleblowing and visit our cornerstone page on qui tam lawsuits.
All inquiries are protected by the attorney – client privilege and kept strictly confidential.
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